1. Technical Field of the Invention
The present invention relates to medical devices and, in particular, to an Airway Management Apparatus for easing the breathing and aiding the alignment of the oral, pharyngeal, and laryngeal axes of an airway of an obese individual in the supine position.
2. Description of Related Art
Airway management concerns the ability to maintain open air passages in an individual, especially during surgical operations where anesthesia is administered to alter the state of consciousness and stabilize body functions. During such operations, the ability of the body to maintain an adequate airway may be compromised, and external airway management procedures must be undertaken to ensure the breathing airway remains open and unobstructed.
Endotracheal intubation, a medical procedure that secures an individual""s airway through placement of a breathing tube in the individual""s trachea in order to facilitate either spontaneous or controlled gas exchange, is routinely carried out in operating rooms after the induction of anesthesia or in emergencies to establish and maintain an adequate airway. The endotracheal intubation process requires an unobstructed airway that is obtained by aligning the oral, pharyngeal, and laryngeal axes in the body. This process is usually achieved without great difficulty under direct vision provided by an instrument such as a laryngoscope that exposes the individual""s vocal cords.
More specifically, an endotracheal intubation is usually performed using a laryngoscope having a rigid straight blade (known as a Miller type blade), or a rigid curved blade (known as a Macintosh type blade) on a supine and anaesthetized individual. During the endotracheal intubation and prior to the individual being connected to a breathing machine, the individual""s breathing is mechanically assisted by a physician or other health professional physically moving air into the individual""s lungs with a ventilation bag.
The most commonly used technique in an endotracheal intubation consists of extending the individual""s neck and rotating the head backwards in order to achieve alignment of the individual""s oral, pharyngeal, and laryngeal axes. Typically, in normal sized individuals, that is an individual having a proper height to weight ratio, the alignment of the oral, pharyngeal, and laryngeal axes is aided by placing a standard pillow or small foam pillow under the individual""s head and neck. Next, the individuals""s mouth is opened and the laryngoscope is introduced into the mouth. Then, the individual""s vocal cords are exposed allowing the endotracheal tube to be inserted through the exposed vocal cords. The tip of the endotracheal tube includes an inflatable collar that is inflated to create a seal on the inside of the trachea. The exterior end of the tube is connected to a breathing machine that sustains the individual""s breathing while under the anesthesia.
Once the breathing tube is in place, a surgical procedure may be conducted on the anaesthetized individual. Following the surgical procedure, the individual is gradually brought out of the anesthesia. At that time, the breathing machine is disconnected, the endotracheal breathing tube is removed, and the individual begins breathing on his own.
It has been found, however, that performing an endotracheal intubation on an obese individual is more difficult. During the endotracheal intubation, the physician attempts to align the oral, pharyngeal and laryngeal axes so that the endotracheal tube can be visually guided into the proper position. At the same time, the physician mechanically assists the obese individual""s breathing by physically moving air into the obese individual""s lungs with a ventilation bag. When working with an obese individual positioned on a standard pillow, the physician is at a mechanical disadvantage due to the abdominal mass of the individual pressing upward against the individual""s diaphragm. To ventilate the supine individual, the physician must exert enough force for the air pressure to move the individual""s diaphragm against the weight of the individual""s abdominal mass. In a normal sized individual, this mass may be easily displaced. In an obese individual, however, the large abdominal mass may be difficult for the physician to displace. Standard prior art pillows do not alleviate this problem.
Moreover, a similar problem occurs following the surgical procedure when the obese individual is brought out of anesthesia and must begin breathing on his own. The obese individual must breathe with enough force to displace his abdominal mass with his diaphragm. Since the individual is still somewhat anaesthetized, it may be difficult for attending personnel to get the individual to breathe with enough force. Standard pillows do not help with this problem.
The magnitude of the problem of managing the airways of obese individuals may be more fully appreciated in view of statistics that indicate that approximately 60% of adults in the United States today qualify as obese. Therefore, a need has arisen for an airway management apparatus that is capable of easing the breathing of obese individuals in the supine position. A need has also arisen for an airway management apparatus that aids in the alignment of the oral, pharyngeal and laryngeal axes in obese individuals.
The present invention disclosed herein comprises an Airway Management Apparatus (AMA) and method that are capable of easing the breathing of obese individuals in the supine position. Additionally, the AMA aids the alignment of the oral, pharyngeal, and laryngeal axes of the airway of these individuals. The AMA achieves these results by providing a head and neck support that is operable to provide support to an individual""s head and neck while the individual is in the supine position. The invention raises the individual""s chest cavity, causing the individual""s abdominal mass to fall away from the chest and diaphragm, thereby easing breathing. Moreover, the AMA positions the individual""s head so that the head may be more easily rotated backwards and positions the individual""s neck so that the neck may be more easily extended, thereby aiding the alignment of the oral, pharyngeal, and laryngeal axes of the airway.
Thus, in one aspect, the present invention is directed to an AMA which includes a head and neck support. The head and neck support includes an upper surface that contacts the head and neck and raises the head and neck above a base surface. An upper-body support is coupled to the head and neck support and supports the individual""s upper body at an angle sufficient to cause the individual""s abdominal mass to fall away from the diaphragm. The upper-body support has a substantially planar top surface that slopes downward from the upper surface of the head and neck support to the base surface.
The head and neck support may include a transverse cylindrical support piece for supporting the individual""s neck, and a substantially planar or concave horizontal support piece for supporting the individual""s head. The AMA may be integrally formed from an elastomeric material such as a foam polyurethane material.
In another aspect, the present invention is directed to an AMA which includes a means for elevating the head and upper body of the individual above a base surface on which the individual is positioned. Additionally, a means is coupled to the elevating means for providing vertical support under the individual""s neck at a height above the individual""s shoulders. Furthermore, a means is coupled to the elevating means and the neck supporting means for supporting the individual""s head at a height approximately equal to or lower than the individual""s neck. Thus by raising the individual""s upper airway, the individual""s head may be rotated backwards and neck extended to aid the alignment of the oral, pharyngeal, and laryngeal axes of the airway. Additionally, a means for supporting the individual""s back may be included. A means for supporting the lower lumbar region and a means for providing additional comfort may also be included.
In yet another aspect, the present invention is directed to a method of reducing the amount of positive air pressure that attending personnel must maintain in a supine obese individual""s lungs to move the individual""s diaphragm. The method includes the steps of raising the individual""s head and neck above the base surface and supporting the individual""s upper body at an angle sufficient to cause the individual""s abdominal mass to fall away from the diaphragm, thereby reducing the amount of air pressure required in the obese individual""s lungs to move the individual""s diaphragm.
In yet another aspect, the present invention is directed to a method of inserting an endotracheal breathing tube into the trachea of an obese individual lying in an approximately supine position on a base surface.
The method includes the steps of reducing the amount of air/airway pressure required in the obese individual""s lungs to move the individual""s diaphragm, ventilating the individual (under anaesthesia), aligning the oral, pharyngeal, and laryngeal axes of the individual to enable visual acquisition of the trachea, and inserting the endotracheal tube into the trachea. The step of reducing the amount of pressure required to move the individual""s diaphragm may be performed by raising the individual""s head and neck approximately six inches above the base surface, and supporting the individual""s upper body at an angle sufficient to cause the individual""s abdominal mass to fall away from the diaphragm. The step of aligning the various airway axes may be performed by extending the individual""s neck over a neck support and extending the individual""s neck and head backward on a head support.
It should be noted that, the AMA and method of the present invention may also be used to treat sleep apnea, gastro esophageal reflux and breathing problems associated with pregnancy.